Provider Demographics
NPI:1821394909
Name:RAY, HOLLY R (RN,ANP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:R
Last Name:RAY
Suffix:
Gender:F
Credentials:RN,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SWIFT AVE
Mailing Address - Street 2:APT 102
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3184
Mailing Address - Country:US
Mailing Address - Phone:816-288-9223
Mailing Address - Fax:866-616-0686
Practice Address - Street 1:6860 W 115TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2457
Practice Address - Country:US
Practice Address - Phone:913-217-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75345363LA2200X
MO2011005427363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health